Comparison of intravascular ultrasound to contrast-enhanced 64-slice computed tomography to assess the significance of angiographically ambiguous coronary narrowings.
The efficacy of contrast-enhanced multislice computed tomography (MSCT) for assessment of ambiguous lesions is unknown. We compared both quantitative coronary angiography (QCA) and MSCT to the gold standard for a significant stenosis-minimum luminal area (MLA) by intravascular ultrasound (IVUS)-in 51 patients (64 +/- 10 years old, 19 men) with 69 angiographically ambiguous, nonleft main lesions. The MSCT was performed 17 +/- 18 days before IVUS analysis. Overall diameter stenosis by QCAwas 51.0 +/- 9.8%; 39 of 51 patients (76%) eventually underwent revascularization (38 by percutaneous coronary intervention and 1 by coronary artery bypass graft). By univariate analysis, minimum luminal diameter, MLA, lumen visibility by MSCT, and minimum luminal diameter by QCA were significant predictors of MLA by IVUS <or=4.0 mm(2). In mildly calcified lesions (calcium burden by MSCT <or=1), MLA by MSCT was a much better predictor than in more calcified lesions. By multivariate logistic regression analysis, only MLA by MSCT (odds ratio 0.754, 95% confidence interval 0.571 to 0.995, p = 0.0458) was predictive of MLA by IVUS <or=4.0 mm(2). In conclusion, in angiographically ambiguous lesions in which QCA does not distinguish significantly from nonsignificant stenosis, MSCT-measured MLA can predict significant stenosis with MLA <or=4.0 mm(2) measured by IVUS.
Okabe
Teruo
T
Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA.
Weigold
Wm Guy
WG
Mintz
Gary S
GS
Roswell
Robert
R
Joshi
Subodh
S
Lee
Sung Yun
SY
Lee
Bongryeol
B
Steinberg
Daniel H
DH
Roy
Probal
P
Slottow
Tina L Pinto
TL
Smith
Kimberly
K
Torguson
Rebecca
R
Xue
Zhenyi
Z
Satler
Lowell F
LF
Kent
Kenneth M
KM
Pichard
Augusto D
AD
Weissman
Neil J
NJ
Lindsay
Joseph
J
Waksman
Ron
R
D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
D003287:Contrast Media; D007479:Iopamidol